Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.

Question: Can I bill for smoking cessation counseling in the ED?

Answer: Yes, you can bill for this. The CPT codes used are time-based (greater than 3 minutes to 10 minutes [99406] and greater than 10 minutes [99407]). You must document the time spent counseling. The service involves specific validated interventions of assessing the patient’s readiness for change, identifying barriers to change, suggesting specific actions for change, motivational counseling, and arranging follow-up. There should be an ICD-10 diagnosis code to support the service, such as Z71.6 (tobacco counseling) with F17.21 (nicotine dependence, cigarettes). This service is reimbursable from many payers and carries an RVU value of 0.35 for 99406 and 0.73 for 99407. However, some payers may put a limit on the number of times per year these codes can be used per patient. We see patients at potentially pivotal moments in their lives and have the opportunity to change their behavior. These CPT codes allow us to bill for these life-altering services.

For more information, please refer to the Behavior Change Intervention FAQ.

Brought to you by the ACEP Coding and Nomenclature Committee.

Dr. Lempert is chief medical officer, coding policy, at TeamHealth, based in Knoxville, Tennessee.